Healthcare Provider Details

I. General information

NPI: 1861838070
Provider Name (Legal Business Name): WILLIAM KUYKENDALL PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 NORTH PECOS ROAD
LAS VEGAS NV
89086
US

IV. Provider business mailing address

6900 NORTH PECOS ROAD
LAS VEGAS NV
89086
US

V. Phone/Fax

Practice location:
  • Phone: 702-791-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number64915
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number18173
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: